Lifestyle and mental health trajectories in university students: Study protocol of the UNILIFE-M multicenter, prospective, nested case-control study

Emerging adulthood is a peak period for the onset of most mental health problems. This period – in which many young people go to college – is also marked by a shift in multiple lifestyle behaviors, including increased time spent in sedentary behavior and physical inactivity, poorer dietary habits, sleep quality, and increased substance use and screen time. Evidence in the general population previously showed associations between such lifestyle behaviors and increased risk for incident mental health problems. However, the role of (changes in) lifestyle behaviors on incident mental health problems in emerging adulthood remains unclear. The present project portrays an international prospective multicenter cohort in Brazil (n=11), Germany (n=11), Australia (n=4), the UK (n=3), Colombia (n=2), the United States of America (n=2), Chile (n=1), New Zealand (n=1), Norway (n=1), Singapore (n=1), Spain (n=1), Suriname (n=1), Switzerland (n=1), and the Netherlands (n=1) and with a nested case-control study, aiming to investigate 1) the relationships between lifestyle and incident mental health problems in university students, 2) the associations of lifestyle correlates (physical fitness) with incident mental health problems, and 3) the potential neurobiological (inflammation/oxidative stress) mediators or moderators of the lifestyle mental health associations. The prospective study will gather self-reported data on lifestyle (diet, physical activity, substance use, stress management, social support, restorative sleep, and screen exposure), mental health problems (symptoms of depression, anxiety, mania, sleep problems, substance abuse, inattention/hyperactivity, and obsessive/compulsive thoughts/behaviors), demographics and academic course of 11,700 freshman students (300/p center). Participants will be assessed at baseline and followed up for 1, 2, and 3.5 years. Participants with positive screening for any mental health problem and age, sex, and body mass index-matched controls will be invited to the case-control study. The case-control study will assess all waves' physical fitness (cardiorespiratory fitness, handgrip strength, and lower limb strength) and biomarkers (inflammation, oxidative stress, and neuroplasticity). The study will advance the field by comprehensively investigating how multiple lifestyle behaviors cluster to predict university students' most prevalent mental health problems during their college years and clarify the role of physical fitness and biomarkers in that relationship.

mental health, lifestyle, students